Secobarbital dependence

Frequently, a preoperative sedative is given to a patient 1 to 2 hours before the administration of general anesthesia.2,36 Sedatives are usually administered orally or by intramuscular injection, and are given while the patient is still in his or her room. This approach serves to relax the patient and reduce anxiety when arriving at the operating room. Commonly used preoperative sedatives include barbiturates (secobarbital, pentobarbital), opioids (butorphanol, meperidine), and benzodiazepines (diazepam, lorazepam) (Table 11-2). Different sedatives are selected depending on the patient, the type of general anesthesia used, and the preference of the physician. 

Barbiturates are addictive. A person may develop a physical dependency after taking more than 400 mg of pentobarbital or secobarbital a day over an approximately 90-day period. 

Schedule II drags have a high potential for abuse. They are accepted for medical use with restrictions. These drugs may lead to severe psychological or physical dependence. Barbiturates in this category are amo-barbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal, Tuinal). 

Several classes of pharmacologic agents are available for insomnia. Barbiturates are the oldest agents that have been used for insomnia and include pentobarbital, secobarbital, and amobarbital. Barbiturates are currently not recommended because of their high abuse potential (due to rapid development of tolerance) and lethal potential in overdose situations. Barbiturates potentiate the GABAergic-induced increase in chloride ion conductance at low doses, and at high doses they depress calcium-dependent action potentials. Caution should be exercised in patients with marked renal or liver dysfunction, severe respiratory disease, suicidal tendencies, or history of alcohol/drug abuse. 

Intravenous lorazepam or diazepam. The use of intravenous secobarbital or phenytoin may also be effective in the therapy of status epilepticus, depending on the origin. 

Schedule 11 drugs have an accepted medical use in the United States and a high rate of abuse, with either severe psychological or physical dependence potential. These drugs include morphine, codeine, cocaine, amphetamine, and most barbiturate preparations containing amobarbital, secobarbital, and pentobarbital. 

---